Heat, ice or anti-inflammatory meds?

As Physiotherapists, we often get asked the question about heat or ice. “Should I use ice or heat on my pulled muscle?” and “Can ice or heat help muscle soreness?”

And it’s not as simple as just one answer. It all depends on the type of injury and what you’re trying to achieve from the application.

As a quick overview of the benefits and risks with each option: 

• Ice (such as a freezeable blue gel ice pack) is used as a mild anti-inflammatory agent and as a pain reliever, particularly within the first few days of an acute injury
  • It’s effective on most superficial injuries but won’t work on deeper injuries, like hip joint pain
  • It carries very little risk other than a skin burn
• Heat (like a microwaveable wheat bag) is often used to warm stiff (but not swollen) joints and as a pain reliever
  • It works well on structures with more blood supply, such as muscle soreness, and larger areas, like the lumbar spine
  • It carries some risk of increasing bleeding after acute injury however this has not been shown to adversely affect recovery times
• Anti-inflammatory meds (like Nurofen, Voltaren and Advil) are used to control inflammatory process, particularly for gradual onset conditions such as arthritis
  • It works on injuries with joint based swelling or acute tendon flare ups
  • The risks are numerous though – they’ve been shown to adversely affect the gut (particularly in high doses and prolonged use), they increase bleeding in the first few days after acute injury and they inhibit the body’s ability to repair itself (especially important after soft tissue damage or bone stress injuries)
  • They should only be used after consulting a pharmacist to discuss your risk factors

Just injured?

If the injury was caused by a single incident (eg. Rolled ankle)

Got swelling and/or bruising? 

• Use ice packs or ice immersion (for approx 10min every few hours) and compression for 3-7 days
• Avoid anti inflammatory meds as they increase bleeding 

No visible swelling or bruising? 

• Use ice packs or ice immersion (for approx 10min every few hours) for 3 days
• Compression isn’t required

Gradual onset of pain over days/weeks?

If the injury had no obvious cause (no incident) 

No visible swelling, no stiffness after rest? 

• It’s unlikely that heat, ice or anti inflammatory meds will be helpful

Visible swelling, no stiffness after rest

• Use ice or anti inflammatory meds daily or after exercising for a short period
• If it’s not responding after 5-7 days, seek medical assessment

Stiffness after rest (ie. on waking in morning) 

• Anti inflammatory meds are usually effective when used daily or in the evening for a short period
•  Ice before bed can also be helpful (10min, applied once or twice in the hour before sleeping)
• If it’s not responding after 5-7 days, seek medical assessment